Assembly Votes Challenge Threats to Patient Care

Patient care issues had a prominent place on the agenda for the APA Assembly's November meeting in Washington, D.C., and several dealt with prescribing concerns in a health care environment that is not always patient friendly.

The representatives passed a paper, for example, whose intent is to“ protect and encourage prescribing” that is both clinically and financially “appropriate.” The proposal addressed the skyrocketing use of drug formularies and pharmacy benefit managers and emphasized that formularies are difficult to use in psychiatry “because of low nosologic specificity, lack of interchangeability of medicines within a class, and a lack of understanding of the mechanism of action of psychotropic medications.” As a result, the Assembly voted to support pharmacy benefit managers that “seek to manage utilization by improving quality, such as by promulgating scientific standards of prescribing through markers of best practices and education.” The vote also included a call to collaborate with the AMA and other specialty organizations on this issue.

The Assembly also issued a call to halt the practice of “managed care pharmacists inciting patients to change their medication regimens without disclosing their profit motive.” Assembly representatives were angry about reports of pharmacists affiliated with managed care plans telling patients that they can save money if they switch to a generic or a brand-name drug on the insurer's formulary and urging them to ask their physicians to change their medication. The proposal was forwarded to several APA components for further input.

Concern about Medicare's Part D program was discussed as well; in particular, the representatives discussed “obstacles” that the Part D pharmacy benefit plans put in front of patients before they can get a drug their physician thinks is the most appropriate. The Assembly voted to have APA compile information on the issues, contact the Centers for Medicare and Medicaid Services “regarding development of standardization of such clinical data throughout the Part D program for all pharmacy plans,” and look at the issue of having Medicare reimburse physicians for the time they expend on prior authorization for and appeals of prescribing decisions.

On other issues the assembly voted to

In addition to these actions, several Assembly awards were presented at last month's meeting. Prominent among them was the Ronald A. Shellow Award, which is named for a beloved past speaker of the Assembly. This year's award went to jeffrey Geller, M.D., of Massachusetts, who served for many years as a district branch representative and more recently as the Assembly's Area 1 representative. Geller now represents Area 1 on the APA Board of Trustees.

Each year, each of APA's seven Areas presents a Warren Williams Award, also named for a former Assembly speaker. Three were presented at last month's meeting. Area 5 presented its award to Doris Shellow, who was the longtime executive director of the South Florida Psychiatric Society before it merged with the Florida Psychiatric society. She was honored for her service to both district branches. She is the widow of Ronald Shellow, M.D.

Area 6 presented its award to James Krajeski, M.D., who was honored for his work as editor in chief of Psychiatric News for the last eight years, as well as his service in the Assembly and the Northern California Psychiatric Society.

The Area 7 Warren Williams Award went to Vit Patel, M.D., the Assembly representative for Hawaii. Patel was honored for his 30 years of service to APA and to the Hawaii district branch, of which he is president-elect.▪